Water pollution, whether of microbiological or chemical origin, can have both short-term (foodborne illnesses) and long-term (cancers) consequences for public health. In France, the water supply undergoes rigorous quality control to ensure it meets food safety standards.

Health risk management and enforcement of regulations fall under the jurisdiction of the Ministry of Health and the Regional Health Agencies (ARS). The French Agency for Food, Environmental and Occupational Health & Safety (ANSES) is responsible for risk assessment and management support, while Santé publique France is responsible for epidemiological surveillance and health alerts to mitigate risks. In this capacity, Santé publique France defines epidemiological indicators that form the foundation for systems to monitor health impacts linked to the environment. The systems currently in place focus in particular on monitoring outbreaks of acute waterborne gastroenteritis.

Epidemiological surveillance of infections linked to water pollution

Santé publique France monitors the incidence of infections caused by these enteric (intestinal) microorganisms.

Surveillance of Legionnaires’ disease is conducted through mandatory reporting.

Surveillance of waterborne acute gastroenteritis outbreaks aims to:

• to provide Regional Health Agencies (ARS) with an epidemiological tool, in addition to water quality surveillance, to identify at-risk water systems and improve the management of infectious risks associated with tap water;

• to establish a consolidated national database to improve understanding of the impact of waterborne acute gastroenteritis outbreaks (time, location, people) and identify the determinants in order to improve prevention tools.

EpiGEH: Development of an Application for Viewing Alerts and Investigation Data

EpiGEH is an internal application developed by Santé publique France and accessible to the public. It serves several objectives:

• to provide feedback on the nature and water-related plausibility of signals detected by the surveillance system;

• enable members of the regional coordination team to update the classification of signals as part of health and environmental investigations of the signals;

• make information derived from the GEAm health indicator available to Santé publique France’s teams and partners (both national and regional) to provide the basis for validating the health impact of environmental signals (e.g., a non-compliance reported by the ARS without a GEA signal at the time of the non-compliance, a pipe rupture, heavy rains, etc.);

• produce a national summary of the indicators.

Since late 2021, the EpiGEH application has been available for direct consultation by all ARSs.

Coordination of cancer registries

Santé publique France also coordinates the cancer registries that operate at the departmental level and provide epidemiologists with cancer data.